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2 Introductions Readiness for MI? Are you ready to learn how to use Motivational Interviewing to help your clients? Take the User Poll and tell me if you are ready! 2

3 What is Motivational Interviewing? Respectful approach Considers where the client is at Considers the client resources Non-judgmental Not a technique but a philosophy of respect and concern, along with a collection of skills Client centered directive method for enhancing motivation to change by exploring and resolving ambivalence 3

4 Dancing Not Wrestling VS. 4

5 Beliefs about Motivation and Change! What kind of things, internal and external, do you think motivate change in yourself and others? In general, how has your field traditionally tried to motivate people to change? Take the User Poll and tell me what motivates you! 5

6 Advantages to Using MI in Any Setting Places responsibility on client to make changes. Client will view you as instrumental in helping them instead of blaming you for their problems. You may be the only healthy individual the client knows. Wouldn t it be great to be a role model for them! Not too soft. Not too hard! 6

7 Favorite Teacher Exercise 7

8 Stages of Change by Prochaska and Diclemente Pre-contemplation or Who me? Contemplation or Maybe but Maybe not. Preparation or I think I can. Action or I can do this! Maintenance or 6 months or more of committed behavior change I m doing it! Relapse? 8

9 Stages of Change 9

10 OARS Open Ended Questions Affirmations Reflections Summary 10

11 Open Ended Questions Vs. Closed Questions An Open Ended Question is likely to receive a longer answer. A Closed Question can be answered with either a single word or a short phrase. A Closed Question can often be answered with yes or no. Open Questions often begin with What, Why, How, Describe or my favorite Tell me about Open Questions ask the respondent to think and reflect. They will give opinions and feelings. They hand control of the conversation to the respondent. There is nothing wrong with Closed Questions to get specific answers/facts that you may need! Try to ask twice as many Open Ended Questions as Closed Questions. 11

12 How to Ask an Open-Ended Question CLOSED QUESTION 1. So you are here because you are concerned about your use of alcohol, correct? OPEN QUESTION Tell me, what is it that brings you here today? 2. How many children do you have? Tell me about your family. 3. Do you agree that it would be a good idea for you to go through detox? 4. On a typical day, how much marijuana do you smoke? What do you think about the possibility of going to detox? Tell me about your marijuana use during a typical week. 5. Do you like to smoke? What are some of the things you like about smoking? 6. How has your drug use been this week, compared to last week: more, less, or about the same? What has your drug use been like during the past week? 7. Do you think you use cocaine too much? In what ways are you concerned about your cocaine use? 8. How long ago did you have your last drink? Tell me about the last time you had a drink. 9. When do you plan to stop drinking alcohol? So what do you think you want to do about your drinking? 12

13 Vacation Exercise Pair up with someone and practice asking them questions about their last vacation or their ideal vacation. Do your best to only ask Open Ended Questions. Do this for 5 minutes then switch. 13

14 Affirmations Provides positive re-enforcement to the client Promotes self-efficacy Acknowledges/validates difficulties the client has experienced Says I hear and understand Provides strength to the client to resolve any ambivalence Must be done sincerely 14

15 Examples of Affirming Statements (Miller and Rollnick 1991) I appreciate how hard it must have been for you to decide to come here. You took a big step. I think it s great that you want to do something about this problem. That must have been very difficult for you. You re certainly a resourceful person to have been able to live with the problem this long and not fall apart. That s a good suggestion! It must be difficult for you to accept a day-to-day life so full of stress. I must say, if I were in your position, I would also find that difficult. 15

16 Reflections Communicates respect Clarifies exactly what the client means Should be a statement, with the inflection turning down at the end So you mean that It sounds like you You re wondering if Don t worry if your reflection is not what the client is saying they ll clarify for you, and you ll have a better understanding! 16

17 Simple Reflections Somewhat like repeating or parroting, but making sure you got the content right. Respond in a very neutral form. Acknowledges and validates what the client has said and can elicit an opposite response. Client: I want to start exercising, but it is hard to find the time. Counselor: Your schedule is very busy, and it is hard to squeeze in another activity. 17

18 Complex Reflections Taking it up a notch! Taking what the client has said and exaggerating what he or she has said in order to raise awareness of need for change or to build discrepancy. Not sarcasm. Client: I don t have a problem unless my friends come by to party. They don t have to work so they can stay out all night. Counselor: So you can make your own choices except when these friends make you party. 18

19 Reflections Require. Continuous tracking of the client s verbal and nonverbal responses and their possible meanings. Understanding the communication style of the client s culture. Formulation of reflections at the appropriate level of complexity. Ongoing adjustment of hypothesis. 19

20 Summary Distills the essence of what the client has expressed and communicates it back to them. Reinforces what the client said. Demonstrates that the clinician has been listening carefully. Help clients consider their responses and experiences. Prepare clients to move forward. 20

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